| 1. |
- Chermá, Maria D., et al.
(författare)
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Methylphenidate for Treating ADHD : A Naturalistic Clinical Study of Methylphenidate Blood Concentrations in Children and Adults With Optimized Dosage.
- 2017
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Ingår i: European journal of drug metabolism and pharmacokinetics. - : Springer Science and Business Media LLC. - 0378-7966 .- 2107-0180. ; 42:2, s. 295-307
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Methylphenidate (MPH), along with behavioral and psychosocial interventions, is the first-line medication to treat attention-deficit hyperactivity disorder (ADHD) in Sweden. The dose of MPH for good symptom control differs between patients. However, studies of MPH concentration measurement in ADHD treatment are limited.OBJECTIVE: To describe blood and oral fluid (OF) concentrations of MPH after administration of medication in patients with well-adjusted MPH treatment for ADHD, and to identify the most suitable matrix for accurate MPH concentration during treatment.METHODS: Patients were recruited from Child and Adolescent Psychiatry (CAP), General Psychiatry (GP), and the Department of Dependency (DD). Blood and OF samples were collected in the morning before MPH administration as well as 1 and 6 h after administration of the prescribed morning dose of MPH.RESULTS: Fifty-nine patients aged between 9 and 69 years, 76 % males. The daily dose of MPH varied from 18 to 180 mg, but the median daily dose per body weight was similar, approximately 1.0 mg/kg body weight. The median MPH concentration in blood 1 and 6 h after the morning dose was 5.4 and 9.3 ng/mL, respectively. Highly variable OF-to-blood ratios for MPH were found at all time points for all three groups.CONCLUSIONS: Weight is a reliable clinical parameter for optimal dose titration. Otherwise, MPH blood concentration might be used for individual dose optimization and for monitoring of the prescribed dose. Relying only on the outcome in OF cannot be recommended for evaluation of accurate MPH concentrations for treatment monitoring.
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| 2. |
- Gustafsson, Berit M., 1966-, et al.
(författare)
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Hyperactivity precedes conduct problems in preschool children : a longitudinal study.
- 2018
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Ingår i: BJPsych Open. - : Cambridges Institutes Press. - 2056-4724. ; 4:4, s. 186-191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Externalising problems are among the most common symptoms of mental health problems in preschool children.Aims: To investigate the development of externalising problems in preschool children over time, and the way in which conduct problems are linked to hyperactivity problems.Method: In this longitudinal study, 195 preschool children were included. Latent growth modelling of conduct problems was carried out, with gender and hyperactivity at year 1 as time-invariant predictors.Results: Hyperactivity was a significant predictor for the intercept and slope of conduct problems. Children with more hyperactivity at year 1 had more conduct problems and a slower reduction in conduct problems. Gender was a significant predictor for the slope of conduct problems.Conclusions: Children with more initial hyperactivity have less of a reduction in conduct problems over time. It is important to consider the role of hyperactivity in studies of the development of conduct problems.Declaration of interest: None.
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| 3. |
- Gustafsson, Berit M., 1966-
(författare)
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Identifying Patterns of Emotional and Behavioural Problems in Preschool children : Facilitating Early Detection
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mental health problems often debut in early childhood and may last throughout adulthood, thereby making early detection and intervention especially important. The overarching aim of the present thesis was to identify patterns of emotional and behavioural problems indicating mental health problems in preschool children. To facilitate the detection of such problems early on, one available screening instrument Strengths and Difficulties Questionnaire (SDQ), was validated. The development and interaction of externalising problems in preschool children were studied over time. Functioning and behaviour and their relations to protective and risk indicators in both environmental and personal characteristics were explored. The long-term goal was to increase knowledge about early identification of emotional and behavioural problems in preschool children in order to facilitate early intervention.In Study I (n=690), the subscales Hyperactivity and Conduct Problems were shown to be valid for children in the age group 1–3 years. A reasonable level of validity was found for the age group 4–5 years when using the original SDQ four-factor solution. The preschool teachers considered most of the SDQ items relevant and possible to rate. Based on the results of Study II (n=815), a score of ≥12 on the SDQ Total Problems Scale is recommended as a cut-off for Swedish preschool children. There were significant differences between boys and girls on all subscales except for the Emotional subscale. The Swedish norms for SDQ are to a large extent similar to findings from other European countries. Study III (n=195) showed that preschool children’s conduct problems decrease over time. Children exhibiting more initial hyperactivity (at year 1) have less reduction in conduct problems over time, i.e. the more hyperactivity early in life, the more conduct problems at year 3. In Study IV (n=197), children high in engagement and social interaction function well over time, even in the presence of hyperactivity, while children with low engagement and interaction alone or in combination with hyperactivity and conduct problems continue to have problems. Stability was related to the existence of a larger number of protective or risk indicators respectively.Taken together, this thesis has shown that the SDQ can be used to identify preschool children at risk of developing mental health problems later in life.
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| 4. |
- Emilsson, Maria, 1966-, et al.
(författare)
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Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
- 2016
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Ingår i: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; , s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to attention deficit hyperactivity disorder (ADHD) treatment is important because, when untreated, it may have serious consequences with lifelong effects. In the case of adolescents on long-term medicine prescription, more knowledge is needed regarding adherence and factors influencing adherence, which was the purpose of this study. Adolescents (n = 101) on ADHD medication ≥6 months were administrated questionnaires at amonitoring appointment: Medication Adherence Report Scale (MARS), beliefs about medicines (BMQ) and the Brief Illness Perception Questionnaire (B-IPQ). Adherencewas high, the mean value was 88% of the maximum MARS score, and correlated positively with the "BMQ necessity-concerns differential" but negatively with "BMQ concerns"and "BMQ-side effects". Adolescents with more belief in the necessity of the medication, less concerns and less experience of side effects tended to be more adherent to medication prescription ("intentional non-adherence"),while "unintentional non-adherence" (forgetfulness) was associated with how much they perceived that their ADHD affected their lives. In a multiple regression model, the variance of MARS total (R2 = 0.21) and “intentional nonadherence” (R2 = 0.24) was explained by the “BMQ-necessity–concern differential” and “BMQ-experienced side effects”. The variance of “unintentional non-adherence” (R2 = 0.12) was explained by the “BMQ-necessity–concern differential” and “B-IPQ-consequences of ADHD”. In conclusion, adolescents on long-term medication reported good adherence, mainly influenced by more beliefs in the necessity versus concerns of the medications, less experienced side effects and more perceived consequences of ADHD. BMQ could be useful to identify risks of low adherence, which should be counteracted by partially gender-specific interventions.
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| 5. |
- Emilsson, Maria, 1966-, et al.
(författare)
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Impact of personality on adherence to and beliefs about ADHD medication, and perceptions of ADHD in adolescents
- 2020
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 20:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background Adherence to attention deficit hyperactivity disorder (ADHD) medication can prevent serious consequences, possibly with lifelong effects. Numerous factors have been observed that influence adherent behaviour, but the impact of personality traits has been inadequately explored. The purpose of this study was to explore the associations between personality traits and adherence to ADHD medication, beliefs about the medication, and perceptions of ADHD. Method Adolescents (n = 99) on ADHD medication were administered: Health-Relevant Personality Traits Five-Factor Inventory, Medication Adherence Report Scale, Beliefs about Medicines Specific and Brief Illness Perceptions Questionnaires. Results The personality trait Antagonism correlated with adherence behaviour (r = - 0.198, p = 0.005) and perceived personal control of ADHD (r = - 0.269, p = 0.007). Negative Affectivity correlated with beliefs regarding necessity (r = 0.319, p = 0.001), concerns (r = 0.344, p = 0.001), and experienced side effects of medication (r = 0.495, p = 0.001), alongside perceptions regarding duration (r = 0.272, p = 0.007), identity (r = 0.388, p < 0.001), being emotionally affected (r = 0.374, p < 0.01), personal control (r = - 0.287, p = 0.004) and concerns about ADHD (r = 0.465, p < 0.001). Impulsivity correlated with perceived consequences (r = - 0.226, p = 0.0255) and personal control of ADHD (r = - 0.379, p < 0.001). Hedonic Capacity correlated with concerns about medication (r = - 0.218, p = 0.0316) and perceived identification with ADHD (r = - 0.203, p = 0.045). Conclusion Personality traits are related to adherence, beliefs about ADHD medicines and perceptions of ADHD. Antagonism is associated with adherence, especially intentional non-adherence, while Negative Affectivity correlates with numerous perceptions of ADHD and beliefs about medications. Personality assessments could be useful in the care and treatment of adolescents with ADHD.
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| 6. |
- Emilsson, Maria, 1966-, et al.
(författare)
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Reliability and validation of Swedish translation of Beliefs about Medication Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with attention-deficit hyperactivity disorder.
- 2020
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 4:2, s. 89-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to assess the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD. Methods: Forward and backward translations of the BMQ-Specific and B-IPQ scales to Swedish were conducted and reviewed by adolescents with ADHD and professionals. The validity and reliability of both questionnaires were investigated in a cross-sectional study of 101 adolescents (13-17 years) on a long-term prescription of ADHD medication recruited from two child and adolescent psychiatric outpatient clinics in Sweden. Results: Regarding the BMQ-Specific, principal component analysis (PCA) loadings confirmed the previously defined components of Specific-Necessity and Specific-Concern. The PCA for B-IPQ revealed two components, the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the capability to manage the ADHD disorder (items 3, 4 and 7). The Cronbach alpha coefficients for BMQ-Specific-Necessity scale was α = 0.80, for BMQ-Specific-Concern scale α = 0.75, B-IPQ Consequences α = 0.74 and for B-IPQ-Control α = 0.44. Conclusions: The present results prove the Swedish translation of BMQ-Specific and B-IPQ to be valid and reliable for utilization in adolescents with ADHD. The PCA confirmed the original components for BMQ-Specific and the recent findings of two main B-IPQ components describing emotional and cognitive implications versus the capability for self-care maintenance of ADHD.
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| 7. |
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| 8. |
- Korhonen, Laura, 1974-, et al.
(författare)
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Slutrapport. Utvärdering av Barnahus : S2018/00212/FST
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I januari 2018 gav regeringen Barnafrid, nationellt centrum för kunskap om våld mot barn, vid Linköpings universitet, i uppdrag att att utvärdera barnahusverksamheterna i Sverige. I uppdraget (Uppdrag angående utvärdering av barnahus S2018/00212/FST) skriver Socialdepartementet att det är angeläget att den samverkan som sker inom barnahus uppfyller de kriterier som finns för vad som ska känneteckna verksamheterna samt att de nationella riktlinjerna är ändamålsenliga (Rikspolisstyrelsen, 2009). I uppdraget önskades identifiering av goda exempel och eventuella brister i syfte att främja ett kvalitativt och likvärdigt bemötande för brottsutsatta barn. I uppdraget anges vidare att ”en utvärdering belyser kvalitet, behovsuppfyllnad, eventuella skillnader och de konsekvenser sådana skillnader kan få för de barn som utgör målgruppen och kan på så sätt utgöra ett viktigt underlag för berörda myndigheter.” I uppdraget ingår inte att lämna åtgärdsförslag.Inom ramen för utvärderingen besöktes 32 barnahus under september 2018 – februari 2019. Vid varje Barnahus genomfördes gruppintervjuer med Barnahusens samverkansparter och samordnare utifrån en intervjuguide. Intervjuerna har analyserats tematiskt utifrån befintliga nationella riktlinjer och kriterier. Då Barnahusen saknar heltäckande statistik för sina verksamheter baseras utvärderingens resultat på egenrapporterad praxis, med andra ord det samverkansparterna och samordnarna själva uppgav att de gör. Därtill inkom Barnahusen med skriftligt material (aktuella samverkansavtal, lokala riktlinjer och rutiner, verksamhetsberättelser, informationsmaterial med mera) och ledamöter i styrgrupper eller motsvarande ombads besvara en enkät med frågor om det egna Barnahuset.I utvärderingen konstateras att det finns många välfungerande barnahus men att det förekommer regionala skillnader i Barnahusens organisation och verksamhet. 68 kommuner, främst i Norra Sverige, Jämtland, Halland och sydöstra delar av Sverige, står utanför Barnahusverksamheten.De främsta brister som lyfts fram av de intervjuade gäller otydligheter i de nationella riktlinjerna (tex. sekretess och den särskilda företrädarens kompetens och roll) samt tillgång till rättsmedicinsk, barnmedicinsk och barn- och ungdomspsykiatrisk kompetens. Det finns beredskap att ge krisstöd till barnet och hens föräldrar, ibland även till trygghetspersonen, efter barnförhör. Uppgifter om i vilken omfattning krisstöd/ behandling erbjuds saknas i denna utvärdering. Det efterfrågas nationell styrning, översikt av de nationella riktlinjerna i samråd med alla Barnahusens samverkansparter, statistik och certifiering av barnahusen. Det finns även behov av att se över målgruppsdefinitionen och att alla Barnahus arbetar utifrån dessa. Utredningen fann brister särskilt då det gällde barn som som bevittnat våld, internetbrott och i vissa fall hedersrelaterat våld.Ur ett barnperspektiv medför de konstaterade regionala skillnaderna en risk för ett icke likvärdigt bemötande, stöd och skydd. Detta kan yttra sig i form av olikheter bland annat gällande definition av målgrupper för Barnahusen, krisstöd och bedömning av vårdbehov, tillgång till barnmedicinsk och barn- och ungdomspsykiatrisk vård, möjlighet att erbjuda frivilliga hälsokontroller samt att tillgodose syskons behov av stöd och behandling. Läget ter sig problematisk för åldersgruppen 15-18 åringar, som nödvändigtvis inte kommer i kontakt med Barnahus.Sammanfattningsvis kan man konstatera att det har sedan 2013 tillkommit ytterligare ett antal Barnahus samtidigt som de grundläggande problemen som belysts i de tidigare utredningarna kvarstår. Det finns dock utrymme för förbättringar då det gäller det multiprofessionella teamarbetet och det tvärsektionella samarbetet, men de stora utmaningarna finns då det gäller behovet av en enhetlig nationell styrning som slår fast att barn som misstänks vara utsatta för brott ska utredas i en barnvänlig miljö där brörda myndigheter samlas och samverkar under ett tak, och där brottsutredning, skydd, samt fysisk och psykisk hälsa beaktas. Vidare saknas en nationell samordning av verksamheten i Barnahus. Befintlig sekretesslagstiftning försvårar samverkan och gör det svårt för Barnahusen att leva upp till de nationella kriterierna. Lagstiftningen förhindrar även gemensam statistikföring och försvårar därmed uppföljning och planering av verksamheten i Barnahus.Genomförandet av uppdraget har skett i dialog med Polismyndigheten, Åklagarmyndigheten, Socialstyrelsen och Rättsmedicinalverket.Uppdraget ska slutredovisas senast den 31 mars 2019, vilket görs härmed i denna rapport.
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| 9. |
- Löfberg, Andreas, 1987-, et al.
(författare)
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Assessing Childhood Maltreatment Exposure in Patients Without and With a Diagnosis of Substance Use Disorder
- 2023
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Ingår i: Journal of addiction medicine. - : Wolters Kluwer. - 1932-0620 .- 1935-3227. ; 17:3, s. 263-270
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Childhood maltreatment (CM), widely held as a risk factor for substance use disorders (SUDs), is commonly assessed using the Childhood Trauma Questionnaire (CTQ). Retrospective self-reports are, however, potentially subject to bias. We used a unique patient sample with prospectively documented CM to examine the performance of the CTQ and how this is affected by the presence of SUD.Methods: Analysis was based on a total of 104 individuals. Subjects with prospectively recorded CM were identified from a specialized childhood trauma unit in Linköping, Sweden (n = 55; 31 with SUD, 61% females; 24 without SUD, 71% females). Clinical controls had SUD but no CM (n = 25, 48% females). Healthy controls had neither SUD nor CM (n = 24, 54% females). We analyzed the agreement between retrospective CTQ scores and prospectively documented CM by κ analysis and assessed the performance of the CTQ to identify CM exposure using receiver operating characteristic (ROC) analysis.Results: Agreement between prospectively and retrospectively recorded CM exposure was poor for sexual abuse (36.6%, Cohen κ = 0.32, P = 0.008) and physical abuse (67.3%, κ = 0.35, P = 0.007). Overall CTQ performance was fair (ROC: area under the ROC curve = 0.78, optimal cutoff = 36.5, sensitivity = 0.65, specificity = 0.75). However, performance was excellent in the absence of SUD (area under the ROC curve = 0.93, cutoff = 32.0, sensitivity = 0.88, specificity = 0.88), but poor in participants with lifetime SUD (area under the ROC curve = 0.62, cutoff = 42.0, sensitivity = 0.60, specificity = 0.36).Conclusions: These data support the CTQ as a tool to assess CM exposure but suggest that it may be less useful in patients with SUD.
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| 10. |
- Perini, Irene, et al.
(författare)
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Brain-based Classification of Negative Social Bias in Adolescents With Nonsuicidal Self-injury : Findings From Simulated Online Social Interaction.
- 2019
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 13, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interpersonal stress and perceived rejection have been clinically observed as common triggers of nonsuicidal self-injury (NSSI), with self-injury behavior regulating both affective and social experiences. We investigated whether the subjective interpretation of social interaction in a simulated online environment might be biased in the NSSI group, and the brain mechanisms underlying the experience.Methods: Thirty female adolescent patients with NSSI and thirty female age-matched controls were investigated in this case-control study. In our novel task that simulates interaction on current social media platforms, participants indicated whether they liked or disliked pictures of other players during a functional magnetic resonance imaging (fMRI) scan. Participants also viewed positive and negative feedback directed toward them by others. The task also assessed the subjective effects of the social interaction. Finally, subjects underwent a separate facial electromyography session, which measured facial expressions processing.Outcomes: Behaviorally, the NSSI group showed a negative bias in processing social feedback from others. A multi-voxel pattern analysis (MVPA) identified brain regions that robustly classified NSSI subjects and controls. Regions in which mutual activity contributed to the classification included dorsomedial prefrontal cortex and subgenual anterior cingulate cortex, a region implicated in mood control. In the NSSI group, multi-voxel classification scores correlated with behavioral sensitivity to negative feedback from others. Results remained significant after controlling for medication, symptoms of depression, and symptoms of borderline personality disorder.Interpretation: This study identified behavioral and neural signatures of adolescents with NSSI during social interaction in a simulated social media environment. These findings highlight the importance of understanding social information processing in this clinical population and can potentially advance treatment approaches.
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